University of Galway

Cities are lived and made and constantly in a state of flux, and the same urban spaces can be used by a variety of people in very different ways. I propose the concept of ‘liquid urbanisms’ to understand these provisional uses of urban space. Liquid urbanisms are provisional places and spaces, connected through the loose and flexible networks of people and projects, that are not immediately obvious but which solidify around a certain project or topic, then become liquid again, until another time in the future. Liquid urbanisms was a helpful concept for me in my research, but also has a wider resonance in how we think about and conceptualise provisional locations in the city. Liquid urbanisms builds on and adds to work in urban studies, focusing attention on the spatial practices of urban actors at the local scale and acknowledging the importance of the temporal in understanding space and place and acknowledging the fluidity of cities. My research conducted in 2013–17 in Dublin initially looked at so‐called ‘temporary spaces’ but quickly grew to include parks, squats, art spaces, urban gardens, autonomous social centres, networking groups and direct actions. I created the conceptual framework of liquid urbanisms to be able to discuss these projects together, as empirically from my research I could see that the projects I was researching had two main shared characteristics: a looser understanding of temporality than existed in mainstream urban planning understandings of the city, and a shared network of people, places and resources, but no body of literature encompassed both of these characteristics. The focus of this article is the concept of liquid urbanisms and how the framework of liquid urbanisms can highlight the different temporalities, spatialities and networks that exist in city spaces, reminding scholars to pay attention to the diverse fluidity of cities. Cities are lived and made and constantly in a state of flux and the same urban spaces can be used by a variety of people in very different ways. I propose the concept of ‘Liquid Urbanisms’ to understand these provisional uses of urban space. Liquid urbanisms are provisional places and spaces, connected through the loose and flexible networks of people and projects, that are not immediately obvious but which solidify around a certain project or topic, then become liquid again, until another time in the future. Liquid urbanisms was a helpful concept for me in my research, but also has a wider resonance in how we think about and conceptualise provisional locations in the city.

Background: Optical flow ratio (OFR) is a novel method for the fast computation of fractional flow reserve (FFR) from optical coherence tomography. Aims: We aimed to evaluate the diagnostic accuracy of OFR in assessing intermediate coronary stenosis using wire-based FFR as the reference. Methods: We performed an individual patient-level meta-analysis of all available studies with paired OFR and FFR assessments. The primary outcome was vessel-level diagnostic concordance of the OFR and FFR, using a cut-off of ≤0.80 to define ischaemia and ≤0.90 to define suboptimal post-percutaneous coronary intervention (PCI) physiology. This meta-analysis was registered in PROSPERO (CRD42021287726). Results: Five studies were finally included, providing 574 patients and 626 vessels (404 pre-PCI and 222 post-PCI) with paired OFR and FFR from 9 international centres. Vessel-level diagnostic concordance of the OFR and FFR was 91% (95% confidence interval [CI]: 88%-94%), 87% (95% CI: 82%-91%), and 90% (95% CI: 87%-92%) in pre-PCI, post-PCI, and overall, respectively. The overall sensitivity, specificity, and positive and negative predictive values were 84% (95% CI: 79%-88%), 94% (95% CI: 92%-96%), 90% (95% CI: 86%-93%), and 89% (95% CI: 86%-92%), respectively. Multivariate logistic regression indicated that a low pullback speed (odds ratio [OR] 7.02, 95% CI: 1.68-29.43; p=0.008) was associated with a higher risk of obtaining OFR values at least 0.10 higher than FFR. Increasing the minimal lumen area was associated with a lower risk of obtaining an OFR at least 0.10 lower than FFR (OR 0.39, 95% CI: 0.18-0.82; p=0.013). Conclusions: This individual patient data meta-analysis demonstrated a high diagnostic accuracy of OFR. OFR has the potential to provide an improved integration of intracoronary imaging and physiological assessment for the accurate evaluation of coronary artery disease.

The pandemic affected more than 1.5 billion students and youth, and the most vulnerable learners were hit hardest, making digital inequality in educational settings impossible to overlook. Given this reality, we, all educators, came together to find ways to understand and address some of these inequalities. As a product of this collaboration, we propose a methodological toolkit: a theoretical kaleidoscope to examine and critique the constitutive elements and dimensions of digital inequalities. We argue that such a tool is helpful when a critical attitude to examine ‘the ideology of digitalism’, its concomitant inequalities, and the huge losses it entails for human flourishing seems urgent. In the paper, we describe different theoretical approaches that can be used for the kaleidoscope. We give relevant examples of each theory. We argue that the postdigital does not mean that the digital is over, rather that it has mutated into new power structures that are less evident but no less insidious as they continue to govern socio-technical infrastructures, geopolitics, and markets. In this sense, it is vital to find tools that allow us to shed light on such invisible and pervasive power structures and the consequences in the daily lives of so many.

Background: Measuring and monitoring safety (MMS) is critical to the success of safety improvement efforts in healthcare. However, a major challenge to improving safety is the lack of high quality information to support performance evaluation. Aims: The aim of this study was to use Vincent et al.'s MMS framework to evaluate the methods used to MMS in Irish hospitals and make recommendations for improvement. Methods: The first phase of this qualitative study used document analysis to review national guidance on MMS in Ireland. The second phase consisted of semi-structured interviews with key stakeholders on their understanding of MMS. The MMS framework was used to classify the methods identified. Results: Six documents were included for analysis, and 24 semi-structured interviews were conducted with key stakeholders working in the Irish healthcare system. A total of 162 methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods, 30 (18.4%) were concerned with past harm, 40 (24.5%) were concerned with the reliability of safety critical processes, 16 (9.8%) were concerned with sensitivity to operations, 28 (17.2%) were concerned with anticipation and preparedness, and 49 (30%) were concerned with integration and learning. Conclusions: There are a wide range of methods of MMS in Irish hospitals. It is suggested that there is a need to identify those methods of MMS that are particularly useful in reducing harm and supporting action and improvement and do not place a large burden on healthcare staff to either use or interpret.

V906 Carinae was one of the best observed novae of recent times. It was a prolific dust producer and harboured shocks in the early evolving ejecta outflow. Here, we take a close look at the consequences of these early interactions through study of high-resolution UVES spectroscopy of the nebular stage and extrapolate backwards to investigate how the final structure may have formed. A study of ejecta geometry and shaping history of the structure of the shell is undertaken following a spectral line $\small {SHAPE}$ model fit. A search for spectral tracers of shocks in the nova ejecta is undertaken and an analysis of the ionised environment. Temperature, density and abundance analyses of the evolving nova shell are presented.

Four decades on from Richard Holt’s pioneering Sport and Society in Modern France (London: Palgrave Macmillan, 1981), few would dispute the assertion by Roxanna Curto and Rebecca Wines that ‘the study of sports is viewed as serious academic business’ (p. 13). More specifically, their Introduction to the present volume highlights the contention by the influential Allen Guttmann that ‘the French were probably the first moderns to make sport into a major literary theme’ (cited p. 13). The thirteen essays that follow offer ample evidence of this creative preoccupation, maintaining the editors’ distinguishing focus on aesthetically significant writing, while also underlining an admirable inclusivity as regards themes and genres. This approach enables the diverse contributions productively to juxtapose the stylistics of running and writing in the novels of Dominique Braga (Thomas Bauer) and Jean Echenoz (Curto), the aesthetics of mountaineering from the Romantics to the clubs alpins (Pierre-Olaf Schut), and some surprisingly subversive depictions of sport and gender in Le Petit Nicolas (Cynthia Laborde). The volume’s targeting of a broadly conceived ‘physical culture’ further allows the inclusion of premodern athletic practices, exemplified by the noble jeu de paume, from the medieval and early modern periods (John McClelland) to the fiction of Prosper Mérimée (Corry Cropper). This broad historical sweep notably includes the Vichy regime’s suppression of rugby league, through a thoughtful reassessment of the writings of rugby union’s most zealous advocate, Paul Voivenel (Keith Rathbone). Such production belongs to a tradition of consciously literary sports commentary, exemplified elsewhere by Henri Desgrange (Wines), Antoine Blondin, and even Roland Barthes, whose 1955 essay on ‘Le Tour de France comme épopée’ was destined to become a cornerstone of cultural studies in his celebrated Mythologies (Ruadhán Cooke). These interrogations of territorial implantation and literary representation together address the complex articulation of professional sports and modern masculinities. They thereby complement the later studies of association football in — and between — France and Algeria, as part of the volume’s broader engagement with the negotiation of sporting identities, an ongoing process in which the 1998 and 2018 FIFA World Cup competitions constitute watershed moments. So, on the one hand, Zinedine Zidane remains the ‘overdetermined’ signifier of the triumphant multiculturalism of 1998 in both literary texts and arthouse cinema (Luke Healey), his parting coup de boule in 2006 notwithstanding. While, on the other, Kylian Mbappé, as player and persona, encourages a critical examination both of the cultural significance of French victory in 2018 and of the durability of the republican model of citizenship. The centrality of football and boxing in banlieue literature (Marshall L. Smith) in turn provides a stimulating counterpoint to the analyses presented here of soccer culture in postcolonial Algerian texts (Christa Jones) and of combat sports in Senegalese novels from the 1960s to the 1980s (Christopher Hogarth). Whether or not sport has entered the mainstream of French and francophone studies remains a moot point, but this fascinating collaboration argues persuasively for taking physical culture seriously, not only as a social barometer but also as a literary field in its own right.

The lifetime of implantable electrochemical glucose monitoring devices is limited due to the foreign body response and detrimental effects from ascorbic acid (AA) and uric acid (UA) interferents that are components of physiological media. Polymer coatings can be used to shield biosensors from these interferences and prolong their functional lifetime. This work explored several approaches to protect redox polymer-based glucose biosensors against such interferences by designing six targeted multi-layer sensor architectures. Biological interferents, like cells and proteins, and UA and AA interferents were found to have individual effects on the current density and operational stability of glucose biosensors, requiring individual protection and treatment. Protection against biofouling can be achieved using a poly(2-methacryloyloxyethyl phosphorylcholine-co-glycidyl methacrylate) (MPC) zwitterionic polymer coating. An enzyme-scavenging approach was compared to electrostatic repulsion by negatively charged polymers for protection against AA and UA interferences. A multi-layer novel polymer design (PD) system consisting of a cross-linkable negatively charged polyvinylimidazole-polysulfostyrene co-polymer inner layer and a cross-linkable MPC zwitterionic polymer outer layer showed the best protection against AA, UA, and biological interferences. The sensor protected using the novel PD shield displayed the lowest mean absolute relative difference between the glucose reading without the interferent and the reading value with the interferent present and also displayed the lowest variability in sensor readings in complex media. For sensor measurements in artificial plasma, the novel PD extends the linear range (R2 = 0.99) of the sensor from 0-10 mM for the control to 0-20 mM, shows a smaller decrease in sensitivity, and retains high current densities. The application of PD multi-target coating improves sensor performance in complex media and shows promise for use in sensors operating in real conditions.

This study looks to understand the uptake of Industry 4.0 and digital technologies by Small and Medium Enterprises and Micro Enterprises in the West of Ireland with a focus on the challenges of Industry 4.0 as well as current integration levels of Industry 4.0. This study finds that there is a high level of awareness of Industry 4.0 and digitalization and its benefits within West of Ireland SME’s and Micro enterprises. However, a sizeable majority are not implementing any Industry 4.0 projects currently, nor is it a part of their strategy. 53% of participant organizations had implemented Lean, with 97% of those only implementing within the last 2 years. The challenges to Industry 4.0 were high costs, lack of state support and fear of choosing the wrong equipment/solution. This is the first empirical study on Industry 4.0 readiness within the West of Ireland Small, Medium and Micro Enterprise space which investigates the understanding of and the readiness for Industry 4.0 as well as the motivation and support required by these enterprises for Industry 4.0. Organizations, including government bodies, can use this study to understand the readiness for digitalization and Industry 4.0 in smaller enterprises as opposed to larger enterprises.

TARP (talipes equinovarus, atrial septal defect (ASD), Robin sequence, persistent left superior vena cava) syndrome is a rare X-linked disorder affecting the RBM10 gene. It was previously viewed as universally fatal in the early neonatal period, however, recent cases have shown patients surviving beyond this stage. We present a male toddler diagnosed with TARP syndrome due to a a previously unreported splicing mutation c.2295+1G>A in the RBM10 gene. At birth, he had an ASD and Robin sequence, two of the eponymous features, as well as other associated phenotypic features. During infancy, he had an extremely high alpha-fetoprotein, conjugated hyperbilirubinaemia and thrombocytopaenia, features not previously described in TARP syndrome. We discuss these findings as well as our patient's survival past the neonatal period with special consideration to recent genotype-phenotypes correlations.

Unlabelled: Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. Purpose: FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. Method: A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland-Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. Results: Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. Conclusions: Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.

Objective: Little is known about the treatment of post-coronavirus disease 2019 (COVID-19) condition (PCC). This article examines the effectiveness of pharmacological interventions for treating people with PCC. Methods: We searched Medline, EMBASE, ClinicalTrials. gov, and the International Clinical Trials Registry Platform. Two independent review authors screened citations, extracted data, and assessed the quality of the included studies. Due to heterogeneity in participants, interventions, and outcomes, we synthesized data narratively. We assessed the certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Participants: People with PCC. Interventions: Pharmacological interventions include corticosteroids, ivabradine, and inhaled hydrogen. Outcome Measures: Olfactory function, sinus tachycardia, respiratory function. Results: We identified 5 completed studies and 41 ongoing studies. Oral corticosteroids and olfactory training had higher olfactory scores after 10 weeks (MD: 5.60, 95% confidence interval [CI]: 1.41 to 9.79). Patients allocated oral corticosteroid, and nasal irrigation demonstrated improved recovery of olfactory function compared with the control group at 40 days (median 60, interquartile range [IQR]: 40 vs. median 30, IQR: 25, p = 0.024). Patients allocated to topical corticosteroid nasal spray and olfactory training had improved recovery of olfactory function after 2 weeks (median 7, IQR: 5−10 vs. median 5, IQR: 2−8, p = 0.08). Participants allocated to ivabradine had a greater mean reduction in heart rate compared with participants randomized to carvedilol (MD: −4.24, 95% CI: −10.09 to 1.61). Participants allocated to inhaled hydrogen therapy had an improved vital capacity (MD: 0.20, 95% CI: 0.07 to 0.33), forced expiratory volume (MD: 0.19, 95% CI: 0.04 to 0.34), 6-minute walk test (MD: 55.0, 95% CI: 36.04 to 73.96).

Primary Aldosteronism is the most common cause of secondary hypertension. First-line treatment; adrenalectomy resects adrenal nodules and adjacent normal tissue, limiting suitability to those who present with unilateral disease. Use of thermal ablation represents an emerging approach as a possible minimally invasive therapy for unilateral and bilateral disease, to target and disrupt hypersecreting aldosterone producing adenomas, while preserving adjacent normal adrenal cortex. To determine the extent of damage to adrenal cells upon exposure to hyperthermia; the steroidogenic adrenocortical cell lines, H295R and HAC15 were treated with hyperthermia at temperatures between 37-50 °C with the effects of hyperthermia on steroidogenesis evaluated following stimulation with forskolin (FSK) and angiotensin II (ANGII). Cell death, protein/mRNA expression of steroidogenic enzymes and damage markers (HSP70/90), and steroid secretion were analysed immediately and 7-days post-treatment. Following treatment with hyperthermia, 42 °C & 45 °C, did not induce cell death and were deemed sublethal doses while ≥50 °C caused excess cell death in adrenal cells. Sublethal hyperthermia (45 °C) caused a significant reduction in cortisol secretion immediately following treatment while differentially affecting the expression of various steroidogenic enzymes, although recovery of steroidogenesis was evident 7-days post-treatment. As such, sublethal hyperthermia, which occurs in the transitional zone during thermal ablation induces a short-lived, un-sustained inhibition of cortisol steroidogenesis in adrenocortical cells in vitro.

Schools are complex physical and social institutions within national education systems. They account for significant energy consumption and like other buildings can demonstrate inefficient patterns of energy use. Poor energy performance of educational facilities is an intricate issue driven by complex causality of interconnected and dynamic factors. Addressing this issue requires a systemic approach, which is heretofore lacking. The aim of this research is to present and describe a systemic framework to facilitate energy reduction in schools across different European contexts. This transdisciplinary approach to sustainable energy use has been piloted in 13 post-primary schools located in six countries in northwest Europe. The research implements a series of planned activities and interventions, which help to unveil a systemic approach to improving energy efficiency in schools. The findings demonstrate how this approach, together with its ensuing methodologies and strategies, can contribute to reducing carbon emissions and improve knowledge and awareness around sustainable energy.

This paper presents a structural performance study of a fibre-reinforced composite blade for a 1 MW tidal turbine rotor blade that was designed for a floating tidal turbine device. The 8-m long blade was manufactured by ÉireComposites Teo and its structural performance was experimentally evaluated under mechanical loading in the Large Structures Research Laboratory at the University of Galway. Composite coupons, applied with an accelerated ageing process, were tested to evaluate the influence of seawater ageing effects on the performance of the materials. The material strength of the composites was found to have a considerable degradation under the seawater ingress. As part of the design stage, a digital twin of the rotor blade was developed, which was a finite-element model based on layered shell elements. The finite-element model was verified to have good accuracy, with a difference of 4% found in the blade tip deflection between the physically measured test results in the laboratory and numerical prediction from the model. By updating the numerical results with the material properties under seawater ageing effects, the structural performance of the tidal turbine blade under the working environment was studied. A negative impact from seawater ingress was found on the blade stiffness, strength and fatigue life. However, the results show that the blade can withstand the maximum design load and guarantee the safe operation of the tidal turbine within its design life under the seawater ingress.

Background: The COVID-19 pandemic accelerated the uptake of digital health interventions for the delivery of cardiac rehabilitation (CR). However, there is a need to evaluate these interventions. Methods: We examined the impact of an evidence-based, digital CR programme on medical, lifestyle and psychosocial outcomes. Delivered by an interdisciplinary team of healthcare professionals, the core components of this 12-week programme included lifestyle modification, medical risk factor management, psychosocial and behavioural change support. To support self-management, patients were provided with a Fitbit, a home blood pressure (BP) monitor and an interactive workbook. Patients received access to a bespoke web-based platform and were invited to attend weekly, online group-based supervised exercise sessions and educational workshops. Outcomes were assessed at baseline, end of programme and at 6-month follow-up. Results: Over a 3-month period, 105 patients (88% with coronary heart disease) were referred with 74% (n=77) attending initial assessment. Of these, 97% (n=75) enrolled in the programme, with 85% (n=64) completing the programme, 86% (n=55) of completers attended 6-month follow-up. Comparing baseline to end of programme, we observed significant improvements in the proportion of patients meeting guideline-recommended targets for physical activity (+68%, p<0.001), BP (+44%, p<0.001) and low-density lipoprotein cholesterol (+27%, p<0.001). There were significant reductions in mean weight (-2.6 kg, p<0.001). Adherence to the Mediterranean diet score improved from 5.2 to 7.3 (p<0.001). Anxiety and depression levels (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The majority of these improvements were sustained at 6-month follow-up. Conclusion: Outcomes from this study suggest that interdisciplinary digital CR programmes can be successfully implemented and help patients achieve guideline recommended lifestyle, medical and therapeutic targets.

Skeletal muscle is one of the most abundant and dynamic tissues of the body, with a strong regenerative capacity. Muscle injuries can occur as a result of a variety of events, including tissue ischaemia. Lower limb ischaemia occurs when there is an insufficient nutrient and oxygen supply, often caused by stenosis of the arteries due to atherosclerosis. The aim of this study was to develop and validate a multiparametric scoring tool for assessing ischaemia severity in skeletal muscle in a commonly used preclinical animal model. Tissue ischaemia was surgically induced in mice by ligation and excision of the femoral artery. Calf muscles were carefully dissected, prepared for histological analysis, and scored for inflammation, fibrosis, necrosis, adipocyte infiltration, and muscle fibre degeneration/regeneration. Kendall’s coefficient of concordance (W) showed a very good agreement between the appraisers when scoring each individual histological feature: inflammation (W = 0.92, p≤0.001), fibrosis (W = 0.94, p≤0.001), necrosis (W = 0.77, p≤0.001), adipocyte infiltration (W = 0.91, p≤0.001), and fibre degeneration/regeneration (W = 0.86, p≤0.001). Intrarater agreement was also excellent (W = 0.94 or more, p≤0.001). There was a statistically significant negative association between the level of muscle ischaemia damage and the calf muscle weight and skeletal muscle fibre diameter. Here, we have developed and validated a new multiparametric, semiquantitative scoring system for assessing skeletal muscle damage due to ischaemia, with excellent inter- and intrarater reproducibility. This scoring system can be used for assessing treatment efficacy in preclinical models of hind limb ischaemia.

Stem cells can undergo asymmetric cell division (ACD) giving rise to one new stem cell and one differentiating daughter cell. In Drosophila germline stem cells (GSCs), the centromeric histone CENP-A - CID in flies - is asymmetrically distributed between sister chromatids such that chromosomes that end up in the GSC harbour more CID at centromeres. A model of 'mitotic drive' has been proposed in GSCs such that stronger and earlier centromere and kinetochore interactions with microtubules bias sister chromatid segregation. Here we show that in Drosophila males, centromere proteins CID, CAL1 and CENP-C are asymmetrically distributed in newly divided GSCs and daughter cells in S-phase. We find that CID overexpression, overexpression of CID together with CAL1 or CENP-C depletion disrupts CID asymmetry, with an increased pool of GSCs relative to daughter cells detectable in the niche. This result suggests a shift toward GSC self-renewal rather than differentiation, important for maintaining tissue homeostasis. Overexpression of CAL1 does not disrupt asymmetry, but instead drives germ cell proliferation in the niche. Our results in male GSCs are comparable to female GSCs, indicating that despite differences in signaling, organisation and niche composition, effects of centromere proteins on GSC maintenance are conserved between the sexes.

We report the case of a 62-year-old woman who presented with an acute inferior wall myocardial infarction complicated by cardiogenic shock and refractory ventricular fibrillation. Following prolonged resuscitation in the emergency room, she was transferred to the cardiac catheterization laboratory where, as a first step, mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (ECMO) was established. Next, a right heart catheterization study was performed, followed by coronary angiography and angioplasty of the infarct-related artery. Promptly on transfer to the intensive care unit, a hypothermia protocol was initiated. By postprocedure day 1, the patient's ventricular fibrillation had resolved, mean arterial pressure was >65 mm Hg, and pulmonary artery diastolic pressure was 10 mm Hg. Echocardiography demonstrated complete recovery of left ventricular systolic function. Lactate levels had fallen from 11.0 mmol/L (pre-ECMO) to 1.2 mmol/L. The patient was successfully weaned off pressor and ECMO support within 24 hours of the percutaneous coronary intervention procedure. She was extubated on postprocedure day 2 and discharged home on day 6. At 26-month follow-up, she remains well, angina free, neurologically intact, and without evidence of heart failure. The treatment algorithm used in this case should be considered favorably in the management of patients presenting with acute myocardial infarction complicated by cardiogenic shock and refractory ventricular fibrillation.